Today was a crazy, long, hectic yet fun day. Orthopedics had two surgeries, one of which was my little buddy from yesterday with the fractured femur and the other was a Tibial Plateau Leveling Osteotomy (lovingly known as a TPLO). The TPLO dog came in yesterday with hind leg lameness and underwent an orthopedic exam. The dog was very tense during the exam and the veterinarian didn't feel that he got an accurate sense of what was going on with the injured leg. Once the dog was sedated for x-rays, the vet re-examined the leg and determined through a drawer sign test that the dog had torn a ligament in its stifle ("knee"). A positive drawer sign test is when the two major bones of the hind limb that form the stifle joint can be moved forward and backward past each other (not normal!!) to indicate that the ligament(s) that usually support the joint are damaged and no longer doing their uber-important job. So, the TPLO surgery was set up for today. TPLO surgery involves removing part of the tibia (lower leg bone) and placing various plates and screws and other fun stuff on/in the bone to stabilize the joint. Cool! However, the ortho group had ample help so I joined up with the neuro kids.
The initial plan in neuro was to do diagnostics on two different dogs, which included MRI. Unfortunately, the MRI was not in the mood to function properly for the majority of the day so we ran a CT scan on dog #1 and had to hold off on diagnostics for dog #2 since the owners would not approve a myelogram and CT in lieu of MRI. Dog #2's (we'll call him Hal) owners came by to see him later in the day. Hal has significant weakness in his hind end and the vet felt that he may have lumbo-sacral disease. Lumbo-sacral disease is basically a general name for degenerative changes that occur in the spine of the lumbar/sacral regions (equivalent to the lower back). Hal's owners were very concerned about him but they were incredibly grateful for the care that he was receiving. We were able to wheel Hal out on a gurney and then assist him with a sling while he walked around the pet exercise area with his owners. A HUGE part of vet med is communicating and interacting with owners. Not all owners are fantastically awesome, but when you come across owners that want to do everything they can for their pet and truly appreciate the effort that we, as medical professionals are putting forth, it's motivating and makes you want to be a more caring, knowledgeable tech.
The MRI got over it's hissy fit around 3pm so we got Hal ready for diagnostics. This is where I learned the importance of ensuring that endotracheal tubes have been properly placed (yeah, really). I administered Propofol in order to induce Hal for spinal radiographs and his MRI and one of the vet students placed the endotracheal tube. Over the next minute or so (seemed like waaaaay longer), Hal began to turn progressively more purple, indicating that his tube was not properly placed...it was most likely in the esophagus (BAD). One of the vets stepped in, placed the tube properly and we began ventilating the patient until he returned to a nice pink color. He then took his dear sweet time to start breathing on his own, but once we got down to radiology, everything was a-ok. It's a little scary to think how many terrible things can happen during a "routine" procedure. One simple thing can be overlooked and an animal can die as a result. Maybe I'm getting all "made for TV movie" cheesy, but people, this is teamwork kind of stuff. Everyone has to be focused on the care and welfare of the patient first and foremost. Those few minutes of insanity when our patient was PURPLE were scary and I don't care to repeat them on a regular basis, thank you very much!
Alright so key points for the day: 1) Grateful people are great! 2) Intubating the esophagus is bad!
3) Teamwork is awesome and beneficial for all involved :)
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